Provider Demographics
NPI:1174618920
Name:LEE, LAI HEUNG CHAN (MD)
Entity type:Individual
Prefix:MRS
First Name:LAI
Middle Name:HEUNG CHAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAI
Other - Middle Name:H
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1310
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-774-6111
Mailing Address - Fax:916-774-6024
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1310
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-774-6111
Practice Address - Fax:916-774-6024
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics